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Paetow H, Streckenbach F, Brandt-Wunderlich C, Schmidt W, Stiehm M, Langner S, Cantré D, Weber MA, Schmitz KP, Siewert S. Development of a bioresorbable self-expanding microstent for interventional applications - an innovative approach for stent-assisted coiling. ROFO-FORTSCHR RONTG 2024; 196:714-725. [PMID: 38092021 DOI: 10.1055/a-2211-2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Hagen Paetow
- Institute for Implant Technology and Biomaterials e.V., Rostock, Germany
| | - Felix Streckenbach
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | | | - Wolfram Schmidt
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Michael Stiehm
- Institute for Implant Technology and Biomaterials e.V., Rostock, Germany
| | - Sönke Langner
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Klaus-Peter Schmitz
- Institute for Implant Technology and Biomaterials e.V., Rostock, Germany
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Stefan Siewert
- Institute for Implant Technology and Biomaterials e.V., Rostock, Germany
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Włodarczak A, Rola P, Włodarczak S, Szudrowicz M, Giniewicz K, Łanocha M, Jaroszewska-Pozorska J, Barycki M, Furtan Ł, Kędzierska M, Włodarczak P, Doroszko A, Lesiak M. Two-Year Outcomes for Patients with Non-ST-Elevation Acute Coronary Syndrome Treated with Magmaris and Absorb Bioresorbable Scaffolds in Large-Vessel Lesions. J Pers Med 2024; 14:540. [PMID: 38793122 PMCID: PMC11122016 DOI: 10.3390/jpm14050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The acute coronary syndrome (ACS) continues to be a fundamental indication for revascularization by percutaneous coronary intervention (PCI). Drug-eluting stent (DES) implantation remains a part of contemporary practice but permanent caging of the vascular structure with the metallic stent structure may increase the rate of device-related adverse clinical events. As an alternative to classic metallic DESs, the bioresorbable scaffolds (BRSs) have emerged as a temporary vascular support technology. We evaluated the mid-term outcomes of two generations of bioresorbable scaffolds-Absorb (Abbott-Vascular, Chicago, IL, USA) and Magmaris (Biotronik, Germany)-in patients with non-ST-elevation ACS. METHODS The study cohort consisted of 193 subjects after Magmaris implantation and 160 patients following Absorb implantation in large-vessel lesions. RESULTS At 2 years, a significantly lower rate of a primary outcome (cardiac death, myocardial infarction, stent thrombosis) was observed with Magmaris (5.2% vs. 15%; p = 0.002). In addition, we observed a significantly lower rate of MI in the target vessel (2.6% vs. 9.4%; p = 0.009) and a lower rate of scaffold thrombosis (0% vs. 3.7%; p = 0.008). The TLF rate between the two groups was not significantly different. CONCLUSION Magmaris demonstrated a good safety profile and more favorable clinical outcomes when compared to Absorb in patients with non-ST-elevation ACS.
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Affiliation(s)
- Adrian Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | | | | | - Joanna Jaroszewska-Pozorska
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | | | - Piotr Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (S.W.); (M.S.); (J.J.-P.); (P.W.)
| | - Adrian Doroszko
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Faculty of Medicine, Wroclaw University of Science and Technology, 50-981 Wroclaw, Poland;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-491 Poznan, Poland;
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Liu D, Yang K, Chen S. Development and Future Trends of Protective Strategies for Magnesium Alloy Vascular Stents. MATERIALS (BASEL, SWITZERLAND) 2023; 17:68. [PMID: 38203922 PMCID: PMC10779993 DOI: 10.3390/ma17010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/09/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
Magnesium alloy stents have been extensively studied in the field of biodegradable metal stents due to their exceptional biocompatibility, biodegradability and excellent biomechanical properties. Nevertheless, the specific in vivo service environment causes magnesium alloy stents to degrade rapidly and fail to provide sufficient support for a certain time. Compared to previous reviews, this paper focuses on presenting an overview of the development history, the key issues, mechanistic analysis, traditional protection strategies and new directions and protection strategies for magnesium alloy stents. Alloying, optimizing stent design and preparing coatings have improved the corrosion resistance of magnesium alloy stents. Based on the corrosion mechanism of magnesium alloy stents, as well as their deformation during use and environmental characteristics, we present some novel strategies aimed at reducing the degradation rate of magnesium alloys and enhancing the comprehensive performance of magnesium alloy stents. These strategies include adapting coatings for the deformation of the stents, preparing rapid endothelialization coatings to enhance the service environment of the stents, and constructing coatings with self-healing functions. It is hoped that this review can help readers understand the development of magnesium alloy cardiovascular stents and solve the problems related to magnesium alloy stents in clinical applications at the early implantation stage.
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Affiliation(s)
- Dexiao Liu
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
- School of Materials Science and Engineering, University of Science and Technology of China, Shenyang 110016, China
| | - Ke Yang
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Shanshan Chen
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
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4
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Truong BQ, Tran H, Nguyen VX, Nguyen CD, Nguyen KD, Vu VH. Mid-term safe and effective profile of the Magmaris scaffold in percutaneous coronary intervention: a prospective, single-center study. Front Cardiovasc Med 2023; 10:1194933. [PMID: 37304961 PMCID: PMC10250636 DOI: 10.3389/fcvm.2023.1194933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Significant advances have been made in the diagnosis and treatment of coronary artery disease over the years. New generations of scaffolds containing novel material and eluting drug have produced one of the most significant advancements in coronary intervention. The newest generation would be Magmaris with a magnesium frame and a sirolimus cover. Methods From July 2018 to August 2020, 58 patients treated with Magmaris at the University Medical Center Ho Chi Minh City were enrolled in this study. Results A total of 60 lesions were stented, 60.3% of which were left anterior descending (LAD) lesions. There was no in-hospital event. Within 1 year after discharge, we noted one myocardial infarction event that required target-lesion revascularization, one stroke event, one non-target-lesion revascularization patient, two target-vessel revascularization patients, and one in-stent thrombosis. Among them, one myocardial infarction occurrence, one non-target-lesion revascularization, and one in-stent thrombosis event were recorded within the first 30 days after discharge. Conclusion In conclusion, the Magmaris scaffold is a safe and effective option for structural procedures performed with imaging device support, particularly intravascular ultrasound.
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Affiliation(s)
- Binh Quang Truong
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Hoa Tran
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Vinh Xuan Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Chinh Duc Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Khang Duong Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
| | - Vu Hoang Vu
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh Center, Ho Chi Minh City, Vietnam
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Yang H, Jin D, Rao J, Shi J, Li G, Wang C, Yan K, Bai J, Bao G, Yin M, Zheng Y. Lithium-Induced Optimization Mechanism for an Ultrathin-Strut Biodegradable Zn-Based Vascular Scaffold. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2301074. [PMID: 36920258 DOI: 10.1002/adma.202301074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Indexed: 05/12/2023]
Abstract
To reduce incidences of in-stent restenosis and thrombosis, the use of a thinner-strut stent has been clinically proven to be effective. Therefore, the contemporary trend is toward the use of ultrathin-strut (≤70 µm) designs for durable stents. However, stents made from biodegradable platforms have failed to achieve intergenerational breakthroughs due to their excessively thick struts. Here, microalloying is used to create an ultrathin-strut (65 µm) zinc (Zn) scaffold with modified biodegradation behavior and improved biofunction, by adding lithium (Li). The scaffold backbone consists of an ultrafine-grained Zn matrix (average grain diameter 2.28 µm) with uniformly distributed nanoscale Li-containing phases. Grain refinement and precipitation strengthening enable it to achieve twice the radial strength with only 40% of the strut thickness of the pure Zn scaffold. Adding Li alters the thermodynamic formation pathways of products during scaffold biodegradation, creating an alkaline microenvironment. Li2 CO3 may actively stabilize this microenvironment due to its higher solubility and better buffering capability than Zn products. The co-release of ionic zinc and lithium enhances the beneficial differential effects on activities of endothelial cells and smooth muscle cells, resulting in good endothelialization and limited intimal hyperplasia in porcine coronary arteries. The findings here may break the predicament of the next-generation biodegradable scaffolds.
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Affiliation(s)
- Hongtao Yang
- Beijing Advanced Innovation Center for Materials Genome Engineering & School of Materials Science and Engineering, Peking University, Beijing, 100871, P. R. China
- School of Engineering Medicine, Beihang University, Beijing, 100191, P. R. China
| | - Dawei Jin
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, P. R. China
| | - Jiancun Rao
- AIM Lab, Maryland NanoCenter, University of Maryland, College Park, MD, 20742, USA
| | - Jiahui Shi
- Beijing Advanced Innovation Center for Materials Genome Engineering & School of Materials Science and Engineering, Peking University, Beijing, 100871, P. R. China
| | - Guannan Li
- Beijing Advanced Innovation Center for Materials Genome Engineering & School of Materials Science and Engineering, Peking University, Beijing, 100871, P. R. China
| | - Cheng Wang
- Institute of Surface Science, Helmholtz-Zentrum Hereon, 21502, Geesthacht, Germany
| | - Kai Yan
- College of Mechanical Engineering, Yangzhou University, Yangzhou, 225127, P. R. China
| | - Jing Bai
- School of Materials Science and Engineering, Southeast University, Nanjing, 211189, P. R. China
| | - Guo Bao
- Department of Reproduction and Physiology, National Research Institute for Family Planning, Beijing, 100081, P. R. China
| | - Meng Yin
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, P. R. China
| | - Yufeng Zheng
- Beijing Advanced Innovation Center for Materials Genome Engineering & School of Materials Science and Engineering, Peking University, Beijing, 100871, P. R. China
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Haddad RN, Adel Hassan A, Al Soufi M, Kasem M. A word of caution: Early failure of Magmaris® bioresorbable stent after pulmonary artery stenting. Catheter Cardiovasc Interv 2023; 101:131-134. [PMID: 36413609 DOI: 10.1002/ccd.30487] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
Bioresorbable scaffolds (BRS) have been advocated as the fourth revolution in interventional cardiology medical devices with promising technology to improve the treatment of coronary artery disease with an event-free future. We describe the first reported use and early collapse of the Magmaris® Resorbable Magnesium Scaffold (RMS) stent (BIOTRONIK AG, Switzerland) to relieve left pulmonary artery severe stenosis in a newborn after the Norwood procedure. The stent collapse was detected 2 weeks after implantation and urgently treated with a balloon-expandable stent. This complication raises the alarm about the need to keep implanted RMS under scrutiny. The possibility of faster scaffold resorption in small babies or lack of sufficient radial force of RMS to resist acute vessel recoil has led to ineffective relief of branch pulmonary artery stenosis and failure to enable a safe short-term bridge to Stage II palliation.
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Affiliation(s)
- Raymond N Haddad
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon
| | - Ahmed Adel Hassan
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Mahmoud Al Soufi
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Mohamed Kasem
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
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Development of 3D printable bioresorbable drug eluting coronary stents: An experimental and computational investigation. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rola P, Włodarczak S, Doroszko A, Lesiak M, Włodarczak A. The bioresorbable magnesium scaffold (Magmaris)-State of the art: From basic concept to clinical application. Catheter Cardiovasc Interv 2022; 100:1051-1058. [PMID: 36229949 DOI: 10.1002/ccd.30435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 11/08/2022]
Abstract
Since its introduction to clinical practice, coronary artery stent implantation has become a crucial part of the therapy of coronary artery disease (CAD). Despite the undeniable evolution of percutaneous coronary revascularization procedures, drug-eluting stent (DES) technology shows some limitations. To overcome these limitations bioresorbable vascular scaffolds (BRS) were designed as a vessel-supporting technology allowing for anatomical and functional restoration of the vessel after the scaffold intended resorption. Various materials have been proposed as the basis of the scaffold backbone. In this narrative review, we present second-generation magnesium-alloy bioresorbable scaffold devices (Magmaris; Biotronik). Additionally, we discuss available preclinical and clinical data regarding this new magnesium BRS.
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Affiliation(s)
- Piotr Rola
- Faculty of Health Science and Physical Culture, Witelon Collegium State University, Legnica, Poland.,Department of Cardiology, Provincial Specialized Hospital in Legnica, Legnica, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Adrian Doroszko
- Clinical Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Adrian Włodarczak
- Faculty of Health Science and Physical Culture, Witelon Collegium State University, Legnica, Poland.,Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
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Rola P, Włodarczak A, Łanocha M, Barycki M, Szudrowicz M, Kulczycki JJ, Jaroszewska-Pozorska J, Gosiewska A, Woźnica K, Lesiak M, Doroszko A. Outcomes of the two generations of bioresorbable scaffolds (Magmaris vs. Absorb) in acute coronary syndrome in routine clinical practice. Cardiol J 2022; 30:VM/OJS/J/86514. [PMID: 35621089 PMCID: PMC10713223 DOI: 10.5603/cj.a2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) as a clinical manifestation of coronary artery disease (CAD) remains a significant cause of mortality and morbidity, as reported worldwide annually. The second generation of drug-eluting stents (DES) is a gold standard in percutaneous interventions in ACS patients however, permanent caging of the vessel with metallic DES has some drawbacks. Bioresorbable vascular scaffolds (BRS) were designed as a temporal vessel-supporting technology allowing for anatomical and functional restoration. Nevertheless, following the initial encouraging reports, numerous concerns about the safety of BRS occurred. METHODS In this study, a 1-year performance of 193 patients with magnesium BRS - Magmaris (Biotronik, Berlin, Germany) was evaluated in comparison to 160 patients with polymer BRS - Absorb (Abbott-Vascular, Chicago, USA) in the non-ST-segment elevation-ACS setting. RESULTS The Magmaris, when compared to Absorb showed a significantly lower rate of primary endpoint (death from cardiac causes, myocardial infarction, stent thrombosis) as well as target lesion failure in 30-day and 1 year follow-up. In the Absorb group, a significantly higher rate of stent thrombosis was observed. CONCLUSIONS Data from the present study suggests encouraging safety a profile and more favorable clinical outcomes of Magnesium BRS in comparison to the polymer Absorb - BRS.
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Affiliation(s)
- Piotr Rola
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland.
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland.
| | - Adrian Włodarczak
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, Legnica, Poland
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | - Jan J Kulczycki
- Department of Cardiology, The Copper Health Center (MCZ), Lubin, Poland
| | | | - Alicja Gosiewska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Woźnica
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
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Bossard M, Madanchi M, Avdijaj D, Attinger-Toller A, Cioffi GM, Seiler T, Tersalvi G, Kobza R, Schüpfer G, Cuculi F. Long-Term Outcomes After Implantation of Magnesium-Based Bioresorbable Scaffolds—Insights From an All-Comer Registry. Front Cardiovasc Med 2022; 9:856930. [PMID: 35498044 PMCID: PMC9046914 DOI: 10.3389/fcvm.2022.856930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/08/2022] [Indexed: 12/18/2022] Open
Abstract
BackgroundThe magnesium-based sirolimus-eluting bioresorbable scaffold (Mg-BRS) Magmaris™ showed promising clinical outcomes, including low rates of both the target lesion failure (TLF) and scaffold thrombosis (ScT), in selected study patients. However, insights regarding long-term outcomes (>2 years) in all-comer populations remain scarce.MethodsWe analyzed data from a single-center registry, including patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), who had undergone percutaneous coronary intervention (PCI) using the Mg-BRS. The primary outcome comprised the device-oriented composite endpoint (DoCE) representing a hierarchical composite of cardiac death, ScT, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR) up to 5 years.ResultsIn total, 84 patients [mean age 62 ± 11 years and 63 (75%) men] were treated with the Mg-BRS devices between June 2016 and March 2017. Overall, 101 lesions had successfully been treated with the Mg-BRS devices using 1.2 ± 0.4 devices per lesion. Pre- and postdilatation using dedicated devices had been performed in 101 (100%) and 98 (97%) of all the cases, respectively. After a median follow-up time of 62 (61–64) months, 14 (18%) patients had experienced DoCEs, whereas ScT was encountered in 4 (4.9%) patients [early ScTs (<30 days) in three cases and two fatal cases]. In 4 (29%) of DoCE cases, optical coherence tomography confirmed the Mg-BRS collapse and uncontrolled dismantling.ConclusionIn contradiction to earlier studies, we encountered a relatively high rate of DoCEs in an all-comer cohort treated with the Mg-BRS. We even observed scaffold collapse and uncontrolled dismantling. This implicates that this metal-based BRS requires further investigation and may only be used in highly selected cases.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- *Correspondence: Matthias Bossard
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Dardan Avdijaj
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
- Faculty of Medicine, University of Zurich, Luzern, Switzerland
| | | | | | - Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Guido Schüpfer
- Department of Anaestesiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
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11
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Characterizing the Mechanical Performance of a Bare-Metal Stent with an Auxetic Cell Geometry. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study develops and characterizes the distinctive mechanical features of a stainless-steel metal stent with a tailored structure. A high-precision femtosecond laser was used to micromachine a stent with re-entrant hexagonal (auxetic) cell geometry. We then characterized its mechanical behavior under various mechanical loadings using in vitro experiments and through finite element analysis. The stent properties, such as the higher capability of the stent to bear upon bending, exceptional advantage at elevated levels of twisting angles, and proper buckling, all ensured a preserved opening to maintain the blood flow. The outcomes of this preliminary study present a potential design for a stent with improved physiologically relevant mechanical conditions such as longitudinal contraction, radial strength, and migration of the stent.
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12
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Barkholt TØ, Neghabat O, Holck EN, Andreasen LN, Christiansen EH, Holm NR. Bioresorbable magnesium scaffold in the treatment of simple coronary bifurcation lesions: The BIFSORB pilot II study. Catheter Cardiovasc Interv 2021; 99:1075-1083. [PMID: 34967094 PMCID: PMC9540410 DOI: 10.1002/ccd.30051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/18/2021] [Accepted: 12/12/2021] [Indexed: 11/09/2022]
Abstract
Objectives To evaluate the feasibility, safety, and healing response of a magnesium‐based bioresorbable scaffold (BRS) in the treatment of simple bifurcation lesions using the single stent provisional technique. Background BRS may hold potential advantages in the treatment of coronary bifurcation lesions, however low radial strength and expansion capacity has been an issue with polymer‐based scaffolds. The magnesium BRS may prove suitable for bifurcation treatment as its mechanical properties are closer to those of permanent metallic drug‐eluting stents. Methods The study was a proof‐of‐concept study with planned inclusion of 20 patients with stable angina pectoris and a bifurcation lesion involving a large side branch (SB) > 2.5 mm with less than 50% diameter stenosis. Procedure and healing response were evaluated by optical coherence tomography (OCT). The main endpoints were a composite clinical safety endpoint and an OCT healing index at 1 month (range: 0–98). Results Eleven patients were included in the study. The study was prematurely terminated due to scaffold fractures and embolization of scaffold fragments in three cases requiring bailout stenting with drug‐eluting stents. One patient underwent bypass surgery at 3 months due to stenosis proximal to the study segment. All SB were patent for 1 month. One‐month OCT evaluation showed strut coverage of 96.9% and no malapposition. Scaffold fractures and uncovered jailing struts resulted in a less favorable mean OCT healing index score of 10.4 ± 9.0. Conclusions Implanting a magnesium scaffold by the provisional technique in nontrue bifurcation lesions was associated with scaffold fracture, embolization of scaffold fragments, and a high need for bailout stenting.
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Affiliation(s)
- Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lene N Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Tidwell K, Harriet S, Barot V, Bauer A, Vaughan MB, Hossan MR. Design and Analysis of a Biodegradable Polycaprolactone Flow Diverting Stent for Brain Aneurysms. Bioengineering (Basel) 2021; 8:bioengineering8110183. [PMID: 34821749 PMCID: PMC8614946 DOI: 10.3390/bioengineering8110183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
Abstract
The flow diverting stent (FDS) has become a promising endovascular device for the treatment of aneurysms. This research presents a novel biodegradable and non-braided Polycaprolactone (PCL) FDS. The PCL FDS was designed and developed using an in-house fabrication unit and coated on two ends with BaSO4 for angiographic visibility. The mechanical flexibility and quality of FDS surfaces were examined with the UniVert testing machine, scanning electron microscope (SEM), and 3D profilometer. Human umbilical vein endothelial cell (HUVEC) adhesion, proliferation, and cell morphology studies on PCL FDS were performed. The cytotoxicity and NO production by HUVECs with PCL FDS were also conducted. The longitudinal tensile, radial, and bending flexibility were found to be 1.20 ± 0.19 N/mm, 0.56 ± 0.11 N/mm, and 0.34 ± 0.03 N/mm, respectively. The FDS was returned to the original shape and diameter after repeated compression and bending without compromising mechanical integrity. Results also showed that the proliferation and adhesion of HUVECs on the FDS surface increased over time compared to control without FDS. Lactate dehydrogenase (LDH) release and NO production showed that PCL FDS were non-toxic and satisfactory. Cell morphology studies showed that HUVECs were elongated to cover the FD surface and developed an endothelial monolayer. This study is a step forward toward the development and clinical use of biodegradable flow diverting stents for endovascular treatment of the aneurysm.
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Affiliation(s)
- Kaitlyn Tidwell
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK 73034, USA; (K.T.); (S.H.); (V.B.)
| | - Seth Harriet
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK 73034, USA; (K.T.); (S.H.); (V.B.)
| | - Vishal Barot
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK 73034, USA; (K.T.); (S.H.); (V.B.)
| | - Andrew Bauer
- Department of Neurosurgery, University of Oklahoma-Health Science Center, Oklahoma City, OK 73104, USA;
| | - Melville B. Vaughan
- Department of Biology, University of Central Oklahoma, Edmond, OK 73034, USA;
- Center of Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Mohammad R. Hossan
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK 73034, USA; (K.T.); (S.H.); (V.B.)
- Center of Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, OK 73034, USA
- Correspondence: ; Tel.: +1-405-975-5295
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Comparison of a Bioresorbable, Magnesium-Based Sirolimus-Eluting Stent with a Permanent, Everolimus-Eluting Metallic Stent for Treating Patients with Acute Coronary Syndrome: the PRAGUE-22 Study. Cardiovasc Drugs Ther 2021; 36:1129-1136. [PMID: 34505954 PMCID: PMC9652234 DOI: 10.1007/s10557-021-07258-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
Background Magnesium-based bioresorbable Magmaris stents are rapidly resorbed. Few randomized studies have evaluated the efficacy of such stents in patients with acute coronary syndrome. Aim To investigate late lumen loss as assessed via quantitative coronary angiography (QCA) and optical coherence tomography (OCT) in patients with acute coronary syndrome treated with Magmaris stents or permanent, everolimus-eluting metallic Xience stents. Methods and Results This PRAGUE-22 study was a two-centre, investigator-initiated, randomized study. Fifty patients were randomized based on the inclusion criteria for acute coronary syndrome and the anatomical suitability to receive Magmaris or Xience stents. The patient characteristics did not differ between the Magmaris group (n = 25) and Xience group (n = 25). The mean ages were 57.0 ± 10.5 vs. 55.5 ± 9.2 years (p = 0.541) and the total implanted stent length was 24.6 ± 10.7 mm vs. 27.6 ± 11.1 mm (p = 0.368), respectively. Four clinical events occurred in the Magmaris group and one in the Xience group during 12 months of follow-up. The extent of late lumen loss (assessed via QCA) at 12 months was greater in the Magmaris group than in the Xience group (0.54 ± 0.70 vs. 0.11 ± 0.37 mm; p = 0.029). The late lumen loss diameter (measured via OCT) in the Magmaris group was also significantly larger than that in the Xience group (0.59 ± 0.37 vs. 0.22 ± 0.20 mm; p = 0.01). Conclusion Implantation of a magnesium-based bioresorbable stent in patients with acute coronary syndrome is associated with a greater extent of late lumen loss at the 12-month follow-up compared with implantation of a permanent, everolimus-eluting metallic stent. Trial Registration: ISRCTN89434356
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Zhao F, Sun J, Xue W, Wang F, King MW, Yu C, Jiao Y, Sun K, Wang L. Development of a polycaprolactone/poly( p-dioxanone) bioresorbable stent with mechanically self-reinforced structure for congenital heart disease treatment. Bioact Mater 2021; 6:2969-2982. [PMID: 33732967 PMCID: PMC7930591 DOI: 10.1016/j.bioactmat.2021.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022] Open
Abstract
Recent progress in bioresorbable stents (BRSs) has provided a promising alternative for treating coronary artery disease. However, there is still lack of BRSs with satisfied compression and degradation performance for pediatric patients with congenital heart disease, leading to suboptimal therapy effects. Here, we developed a mechanically self-reinforced composite bioresorbable stent (cBRS) for congenital heart disease application. The cBRS consisted of poly(p-dioxanone) monofilaments and polycaprolactone/poly(p-dioxanone) core-shell composite yarns. Interlacing points in cBRS structure were partially bonded, offering the cBRS with significantly higher compression force compared to typical braids and remained good compliance. The suitable degradation profile of the cBRS can possibly preserve vascular remodeling and healing process. In addition, the controllable structural organization provides a method to customize the performance of the cBRS by altering the proportion of different components in the braids. The in vivo results suggested the cBRS supported the vessel wall similar to that of metallic stent. In both abdominal aorta and iliac artery of porcine, cBRS was entirely endothelialized within 1 month and maintained target vessels with good patency in the 12-month follow-up. The in vivo degradation profile of the cBRS is consistent with static degradation results in vitro. It is also demonstrated that there is minimal impact of pulsatile pressure of blood flow and variation of radial force on the degradation rate of the cBRS. Moreover, the lumen of cBRS implanted vessels were enlarged after 6 months, and significantly larger than the vessels implanted with metallic stent in 12 months.
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Affiliation(s)
- Fan Zhao
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
- Wilson College of Textiles, North Carolina State University, Raleigh, 27606, USA
| | - Jing Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wen Xue
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Fujun Wang
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Martin W. King
- Wilson College of Textiles, North Carolina State University, Raleigh, 27606, USA
| | - Chenglong Yu
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Yongjie Jiao
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lu Wang
- College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai, 201620, China
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Haude M, Toelg R, Lemos PA, Christiansen EH, Abizaid A, von Birgelen C, Neumann FJ, Wijns W, Ince H, Kaiser C, Lim ST, Escaned J, Eeckhout E, Garcia-Garcia HM, Waksman R. Sustained safety and performance of a second-generation sirolimus-eluting absorbable metal scaffold: Long-term data of the BIOSOLVE-II first-in-man trial at 5 years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:106-110. [PMID: 34364807 DOI: 10.1016/j.carrev.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Permanent drug-eluting stents are associated with a steady increase of late complications attributed to persistent inflammation and poor vessel remodelling. Bioresorbable scaffolds have been developed to overcome such long-term limitations by providing temporary vessel support and disappearing thereafter. We aimed to assess the long-term outcomes of an absorbable metallic scaffold at 5 years. METHODS BIOSOLVE-II is an international, multi-centre, first-in-human study assessing the safety and performance of the sirolimus-eluting absorbable metal scaffold DREAMS 2G (commercial name Magmaris) in patients with a maximum of two de novo lesions. After 3 years, follow-up was extended to 5 years with the endpoints target lesion failure and rate of definite or probable stent thrombosis. RESULTS 123 patients with 123 lesions were enrolled. Lesions were 12.6 ± 4.5 mm long and 2.7 ± 0.4 mm in diameter, 43.4% were class B2/C lesions, and calcification was moderate to severe in 10.6%. At 5 years, 5.4% of patients had stable angina and 94.6% had no symptoms or ischemia. Target lesion failure rate was 8.0% [95% CI:4.2;14.9], reflecting 2 cardiac deaths, 2 target-vessel myocardial infarction, and 6 clinically-driven target lesion revascularizations. Only one target lesion failure occurred beyond 3 years; a target-vessel myocardial infarction with clinically-driven TLR on post-procedure day 1157. One additional non-cardiac death beyond 3 years due to renal failure was reported on day 1777. No definite or probable scaffold thrombosis was observed. CONCLUSION The Magmaris scaffold showed favourable long-term safety and clinical performance with low target lesion failure rates and absence of definite or probable scaffold thrombosis throughout 5 years. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II is a prospective, multi-centre, first-in-man trial enrolling 123 patients with de novo coronary artery lesions. Target lesion failure rate at 5 years was low (8.0%), including 2 cardiac deaths, 2 target-vessel myocardial infarction and 6 clinically-driven target lesion revascularizations. No definite or probable scaffold thrombosis was observed.
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Affiliation(s)
- Michael Haude
- Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany.
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração - HCFMUSP, University of Sao Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Christoph Kaiser
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Eric Eeckhout
- CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Verheye S, Wlodarczak A, Montorsi P, Torzewski J, Bennett J, Haude M, Starmer G, Buck T, Wiemer M, Nuruddin AAB, Yan BP, Lee MK. BIOSOLVE-IV-registry: Safety and performance of the Magmaris scaffold: 12-month outcomes of the first cohort of 1,075 patients. Catheter Cardiovasc Interv 2021; 98:E1-E8. [PMID: 32881396 PMCID: PMC8359313 DOI: 10.1002/ccd.29260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/07/2020] [Accepted: 08/22/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVES We aimed to assess the safety and performance of the Magmaris sirolimus-eluting bioresorbable magnesium scaffold in a large patient population. BACKGROUND Magmaris has shown good outcomes in small-sized controlled trials, but further data are needed to confirm its usability, safety, and performance. METHODS BIOSOLVE-IV is an international, single arm, multicenter registry including patients with a maximum of two single de novo lesions. Follow-up is scheduled up to 5 years; the primary outcome is target lesion failure (TLF) at 12 months. RESULTS A total of 1,075 patients with 1,121 lesions were enrolled. Mean patient age was 61.3 ± 10.5 years and 19.2% (n = 206) presented with non-ST-elevation myocardial infarction (NSTEMI). Lesions were 3.2 ± 0.3 mm in diameter and 14.9 ± 4.2 mm long; 5.1% (n = 57) were bifurcation lesions. Device success was 97.3% (n = 1,129) and procedure success 98.9% (n = 1,063). The Kaplan-Meier estimate of TLF at 12 months was 4.3% [95% confidence interval, CI: 3.2, 5.7] consisting of 3.9% target lesion revascularizations, 0.2% cardiac death, and 1.1% target-vessel myocardial infarction. Definite/probable scaffold thrombosis occurred in five patients (0.5% [95% CI: 0.2, 1.1]), thereof four after early discontinuation of antiplatelet/anticoagulation therapy. CONCLUSION BIOSOLVE-IV confirms the safety and performance of the Magmaris scaffold in a large population with excellent device and procedure success and a very good safety profile up to 12 months in a low-risk population.
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Affiliation(s)
- Stefan Verheye
- Interventional CardiologyZNA Cardiovascular Center MiddelheimAntwerpBelgium
| | | | - Piero Montorsi
- Department of Clinical Sciences and Community HealthUniversity of Milan and Centro Cardiologico Monzino, IRCCSMilanItaly
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu‐KemptenKemptenGermany
| | - Johan Bennett
- Department of Cardiovascular MedicineUniversity Hospitals LeuvenLeuvenBelgium
| | - Michael Haude
- Medical Clinic I Städtische Kliniken Neuss Lukaskrankenhaus GmbHNeussGermany
| | | | - Thomas Buck
- Department of CardiologyHerz Zentrum Westfalen, Klinikum WestfalenDortmundGermany
| | - Marcus Wiemer
- Department of Cardiology and Intensive CareJohannes Wesling University Hospital Ruhr University BochumMindenGermany
| | | | - Bryan P.‐Y. Yan
- Division of Cardiology, Department of Medicine and TherapeuticsPrince of Wales HospitalHong KongHong Kong
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Antonini L, Berti F, Isella B, Hossain D, Mandelli L, Pennati G, Petrini L. From the real device to the digital twin: A coupled experimental-numerical strategy to investigate a novel bioresorbable vascular scaffold. PLoS One 2021; 16:e0252788. [PMID: 34086820 PMCID: PMC8177663 DOI: 10.1371/journal.pone.0252788] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022] Open
Abstract
The purpose of this work is to propose a workflow that couples experimental and computational activities aimed at developing a credible digital twin of a commercial coronary bioresorbable vascular scaffold when direct access to data about material mechanical properties is not possible. Such a situation is be faced when the manufacturer is not involved in the study, thus directly investigating the actual device is the only source of information available. The object of the work is the Fantom® Encore polymeric stent (REVA Medical) made of Tyrocore™. Four devices were purchased and used in mechanical tests that are easily reproducible in any mechanical laboratory, i.e. free expansion and uniaxial tension testing, the latter performed with protocols that emphasized the rate-dependent properties of the polymer. Given the complexity of the mechanical behaviour observed experimentally, it was chosen to use the Parallel Rehological Framework material model, already used in the literature to describe the behaviour of other polymers, such as PLLA. Calibration of the material model was based on simulations that replicate the tensile test performed on the device. Given the high number of material parameters, a plan of simulations was done to find the most suitable set, varying each parameter value in a feasible range and considering a single repetitive unit of the stent, neglecting residual stresses generated by crimping and expansion. This strategy resulted in a significant reduction of computational cost. The performance of the set of parameters thus identified was finally evaluated considering the whole delivery system, by comparing the experimental results with the data collected simulating free expansion and uniaxial tension testing. Moreover, radial force testing was numerically performed and compared with literature data. The obtained results demonstrated the effectiveness of the digital twin development pipeline, a path applicable to any commercial device whose geometric structure is based on repetitive units.
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Affiliation(s)
- Luca Antonini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Francesca Berti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Benedetta Isella
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Dipok Hossain
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Lorenzo Mandelli
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milano, Italy
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High Magnesium and Sirolimus on Rabbit Vascular Cells-An In Vitro Proof of Concept. MATERIALS 2021; 14:ma14081970. [PMID: 33919969 PMCID: PMC8070902 DOI: 10.3390/ma14081970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/30/2022]
Abstract
Drug-eluting bioresorbable scaffolds represent the last frontier in the field of angioplasty and stenting to treat coronary artery disease, one of the leading causes of morbidity and mortality worldwide. In particular, sirolimus-eluting magnesium-based scaffolds were recently introduced in clinical practice. Magnesium alloys are biocompatible and dissolve in body fluids, thus determining high concentrations of magnesium in the local microenvironment. Since magnesium regulates cell growth, we asked whether high levels of magnesium might interfere with the antiproliferative action of sirolimus. We performed in vitro experiments on rabbit coronary artery endothelial and smooth muscle cells (rCAEC and rSMC, respectively). The cells were treated with sirolimus in the presence of different concentrations of extracellular magnesium. Sirolimus inhibits rCAEC proliferation only in physiological concentrations of magnesium, while high concentrations prevent this effect. On the contrary, high extracellular magnesium does not rescue rSMC growth arrest by sirolimus and accentuates the inhibitory effect of the drug on cell migration. Importantly, sirolimus and magnesium do not impair rSMC response to nitric oxide. If translated into a clinical setting, these results suggest that, in the presence of sirolimus, local increases of magnesium concentration maintain normal endothelial proliferative capacity and function without affecting rSMC growth inhibition and response to vasodilators.
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Galli S, Testa L, Montorsi P, Bedogni F, Pisano F, Palloshi A, Mauro C, Contarini M, Varbella F, Esposito G, Caramanno G, Secco GG, D'Amico G, Musumeci G, Tarantini G. SICI-GISE position document on the use of the Magmaris resorbable magnesium scaffold in clinical practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:11-16. [PMID: 33674219 DOI: 10.1016/j.carrev.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Bioresorbable scaffolds have emerged as a potential breakthrough for the treatment of coronary artery lesions. The need for drug release and plaque scaffolding is temporary, and leaving a permanent stent once the process of plaque recoil and vessel healing has ended might be superfluous or even deleterious exposing the patient to the risk of very late thrombosis, eliminating vessel reactivity, impairing non-invasive imaging and precluding possible future surgical revascularization. This long-term potential limitation of permanent bare metal stents might be overcome by using a resorbable scaffold. The metallic and antithrombotic properties make the resorbable magnesium scaffold an appealing technology for the treatment of coronary artery lesions. Notwithstanding this, its mechanical properties substantially differ from those of conventional bare metal stents, and previous experience using polymer-based scaffolds has shown that a standardized implantation technique and optimal patient and lesion selection are key factors for a successful implantation. A panel of expert cardiologists gathered to find a consensus on the best practices for Magmaris implantation in a selected patient population and to discuss the rationale for new potential future indications.
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Affiliation(s)
- Stefano Galli
- Monzino Cardiology Centre Research and Teaching Hospital, University of Milan, Italy.
| | - Luca Testa
- Policlinico San Donato Research and Teaching Hospital, San Donato Milanese, Milan, Italy
| | - Piero Montorsi
- Monzino Cardiology Centre Research and Teaching Hospital, University of Milan, Italy
| | - Francesco Bedogni
- Policlinico San Donato Research and Teaching Hospital, San Donato Milanese, Milan, Italy
| | - Francesco Pisano
- Department of Cardiology, Umberto Parini Regional Hospital, Aosta, Italy
| | - Altin Palloshi
- Department of Cardiology, "Città Studi" Clinical Institute, Milan, Italy
| | | | - Marco Contarini
- Interventional Cardiology Unit, Umberto I Hospital, Syracuse, Italy
| | | | | | - Giovanni Caramanno
- Interventional Cardiology Unit, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Gioel Gabrio Secco
- Department of Cardiology, Ospedale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianpiero D'Amico
- Padua University Policlinico Hospital, Centro Gallucci, Padua, Italy
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21
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Tian Y, Liu M, Liu W, Cheng J, Wu G, Han T, Zhang Y, Zhao G, Ni Z. Effects of annealing temperature on both radial supporting performance and axial flexibility of poly(L‐lactic acid) braided stents. J Appl Polym Sci 2021. [DOI: 10.1002/app.50517] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yuan Tian
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Muqing Liu
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Wentao Liu
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Jie Cheng
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Gensheng Wu
- School of Mechanical and Electronic Engineering Nanjing Forestry University Nanjing China
| | - Ting Han
- Department of Thermal Analysis Instrument Mettler‐Toledo Company Shanghai China
| | - Yi Zhang
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School Southeast University Nanjing China
| | - Gutian Zhao
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
| | - Zhonghua Ni
- School of Mechanical Engineering, Jiangsu Key Laboratory for Design and Manufacture of Micro‐Nano Biomedical Instruments Southeast University Nanjing China
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22
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Demola P, Meucci F, Stolcova M, Mario CD, Mattesini A. The DESolve ® novolimus bioresorbable scaffold. Future Cardiol 2021; 17:945-951. [PMID: 33507091 DOI: 10.2217/fca-2020-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A longtime aspiration of interventional cardiologists remains to improve the long-term impact of stent permanence in coronaries to restore original vessel patency and physiological endothelium response. Bioresorbable vascular scaffolds were considered revolutionary in coronary devices, but several trials were disappointing; thus, the challenge in this field remains. DESolve is a novolimus-eluting poly-L lactide-based polymer scaffold that dissolves through a bio-reabsorption mechanism, vanishing completely in 2 years. Its ability to supply the necessary radial strength to support the vessel for the critical early months after delivery is an important feature showing a unique self-correction property, which reduces incomplete stent apposition. Overexpansion has a good, safe margin with DESolve. This review aims to provide an overview of this controversial topic.
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Affiliation(s)
- Pierluigi Demola
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
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Cakal B, Cakal S, Karaca O, Omaygenc MO, Yilmaz FK, Gunes HM, Ozcan OU, Yıldırım A, Boztosun B. Long-term comparison of everolimus- vs. novolimus-eluting bioresorbable vascular scaffolds in real world patients. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:391-398. [PMID: 33598011 PMCID: PMC7863837 DOI: 10.5114/aic.2020.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/22/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Elevated risk of adverse events in comparison to metallic stents resulted in withdrawal of everolimus-eluting bioresorbable scaffolds (eBVS), known as the most intensively studied BVS. There is a paucity of data comparing the two different BVS. AIM To evaluate the long-term clinical outcomes of the novolimus-eluting bioresorbable vascular scaffold (nBVS) compared with eBVS. MATERIAL AND METHODS Consecutive patients treated with nBVS or eBVS in our center were screened. The primary outcome was the 3-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), and target-lesion revascularization (TLR). RESULTS After matching, 98 patients treated with 135 eBVS were compared with 98 patients treated with 136 nBVS. Baseline characteristics, clinical presentation, and lesion characteristics were comparable in both groups. The 3-year MACE rate was higher in the eBVS group (17.3% vs. 6.1%; p log-rank = 0.02). The occurrence of TLR (16.3% vs. 5.1%; p log-rank = 0.02) and TV-MI (8.2% vs. 0 %; p log-rank = 0.004) was also higher in the eBVS group except for cardiac deaths (1% vs. 2%; p log-rank = 0.98, eBVS vs. nBVS, respectively). Of note, definite device thrombosis rate was markedly increased in the eBVS group (5.1% vs. 0%; p log-rank = 0.03). CONCLUSIONS The present study revealed that the 3-year event risk was lower for nBVS compared to eBVS. More evidence is needed to evaluate long-term performance of novolimus-eluting biovascular platforms.
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Affiliation(s)
- Beytullah Cakal
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Sinem Cakal
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Oguz Karaca
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | | | | | - Haci Murat Gunes
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Ozgur Ulas Ozcan
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Arzu Yıldırım
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Bilal Boztosun
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
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Multimodal Loading Environment Predicts Bioresorbable Vascular Scaffolds' Durability. Ann Biomed Eng 2020; 49:1298-1307. [PMID: 33123828 DOI: 10.1007/s10439-020-02673-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Bioresorbable vascular scaffolds were considered the fourth generation of endovascular implants deemed to revolutionize cardiovascular interventions. Yet, unexpected high risk of scaffold thrombosis and post-procedural myocardial infractions quenched the early enthusiasm and highlighted the gap between benchtop predictions and clinical observations. To better understand scaffold behavior in the mechanical environment of vessels, animal, and benchtop tests with multimodal loading environment were conducted using industrial standard scaffolds. Finite element analysis was also performed to study the relationship among structural failure, scaffold design, and load types. We identified that applying the combination of bending, axial compression, and torsion better reflects incidence observed in-vivo, far more than tranditional single mode loads. Predication of fracture locations is also more accurate when at least bending and axial compression are applied during benchtop tests (>60% fractures at connected peak). These structural failures may be initiated by implantation-induced microstructural damages and worsened by cyclic loads from the beating heart. Ignoring the multi-modal loading environment in benchtop fatigue tests and computational platforms can lead to undetected potential design defects, calling for redefining consensus evaluation strategies for scaffold performance. With the robust evaluation strategy presented herein, which exploits the results of in-vivo, in-vitro and in-silico investigations, we may be able to compare alternative designs of prototypes at the early stages of device development and optimize the performance of endovascular implants according to patients-specific vessel dynamics and lesion configurations in the future.
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Abellas-Sequeiros RA, Ocaranza-Sanchez R, Bayon-Lorenzo J, Santas-Alvarez M, Gonzalez-Juanatey C. 12-month clinical outcomes after Magmaris percutaneous coronary intervention in a real-world cohort of patients: Results from the CardioHULA registry. Rev Port Cardiol 2020; 39:421-425. [PMID: 32763098 DOI: 10.1016/j.repc.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Clinical evidence on the bioresorbable magnesium scaffolds (BRS) is still scarce. We aim to assess clinical outcomes after magnesium BRS deployment in a real-world cohort of patients. METHODS We included in a non-randomized, prospective, single-center registry of all patients treated with at least one Magmaris device in our cath lab. Pre and postdilatation with optical coherence tomography guidance, as part of the 4Ps strategy, were performed in all cases. The primary endpoint was target lesion failure (TLF) at 12 months. RESULTS 42 patients (with 42 lesions) underwent Magmaris percutaneous coronary intervention (PCI) between June 2016 to April 2017. PCI was performed in an acute setting in 54.76% cases; the most treated vessel was the anterior descending artery, with a mean diameter of 3.30±0.25 mm. All lesions underwent predilatation and postdilatation, with a mean postdilatation pressure of 19.2 atm. Procedural success rate was 100%. TLF rate was 4.7% at 12 months. None of our patients died or suffered myocardial infarction. Two patients (4.7%) underwent clinically-driven target lesion revascularization due to in-stent restenosis. No stent thrombosis was detected. CONCLUSION 12-months clinical outcomes after Magmaris PCI demonstrate its safety and feasibility when deployed in a 4Ps strategy.
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Affiliation(s)
- Rosa A Abellas-Sequeiros
- Interventional Cardiology Unit, Lucus Augusti Universitary Hospital, Lugo, Spain; Doctoral fellow, University of Santiago de Compostela (USC), Santiago de Compostela University, Spain
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Abellas-Sequeiros RA, Ocaranza-Sanchez R, Bayon-Lorenzo J, Santas-Alvarez M, Gonzalez-Juanatey C. 12-month clinical outcomes after Magmaris percutaneous coronary intervention in a real-world cohort of patients: Results from the CardioHULA registry. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhou C, Feng X, Shi Z, Song C, Cui X, Zhang J, Li T, Toft ES, Ge J, Wang L, Zhang H. Research on elastic recoil and restoration of vessel pulsatility of Zn-Cu biodegradable coronary stents. ACTA ACUST UNITED AC 2020; 65:219-227. [PMID: 31527289 DOI: 10.1515/bmt-2019-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/24/2019] [Indexed: 11/15/2022]
Abstract
Coronary stents made of zinc (Zn)-0.8 copper (Cu) (in wt%) alloy were developed as biodegradable metal stents (Zn-Cu stents) in this study. The mechanical properties of the Zn-Cu stents and the possible gain effects were characterized by in vitro and in vivo experiments compared with 316L stainless steel stents (316L stents). Young's modulus of the as-extruded Zn-0.8Cu alloy and properties of the stents, including their intrinsic elastic recoil, stent trackability were evaluated compared with 316L stents. In vivo study was also conducted to evaluate restoration of pulsatility of vessel segment implanted stents. Both Zn-Cu stents and 316L stents have good acute lumen gain. By comparison, the advantages of Zn-Cu stents are as follows: (I) Zn-Cu stents have less intrinsic elastic recoil than 316L stents; (II) stent trackability indicates that Zn-Cu stents have a smaller push force when passing through curved blood vessels, which may cause less mechanical stimulation to blood vessels; (III) in vivo study suggests that Zn-Cu stents implantation better facilitates the recovery of vascular pulsatility.
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Affiliation(s)
- Chao Zhou
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Xiangyi Feng
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Zhangzhi Shi
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Caixia Song
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Xiaoshan Cui
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Junwei Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China
| | - Ting Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Egon Steen Toft
- Vice President for Medical and Health Sciences, Medical and Health Sciences Office, College of Medicine, Qatar University, Doha, Qatar
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, P.R. China
| | - Luning Wang
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, P.R. China
| | - Haijun Zhang
- Department of Interventional and Vascular Surgery, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai 200072, P.R. China.,Branden Industrial Park, Qihe Economic and Development Zone, Dezhou City, Shandong 251100, P.R. China.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Cakal B, Cakal S, Karaca O, Omaygenc MO, Yilmaz FK, Gunes HM, Ozcan OU, Ibisoglu E, Boztosun B. Outcomes of the novolimus-eluting bioresorbable vascular scaffold in real world clinical practice. Minerva Cardiol Angiol 2020; 69:261-268. [PMID: 32326676 DOI: 10.23736/s2724-5683.20.05138-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most of the current data regarding the use of bioresorbable scaffolds (BRS) come from everolimus-eluting stent platforms. Adverse events with the everolimus-eluting BRSs which are the most comprehensively characterized BRS, hampered the clinical use of other BRS. There is paucity of published data regarding long term use of novolimus-eluting BRS. METHODS This study sought to evaluate the performance of novolimus-eluting BRS device at midterm follow-up in real world clinical practice. One hundred and forty-four patients (mean age 57.5±9.7 years, 78.5% male) treated with 206 scaffolds between October 2015 and December 2017 were enrolled. A device-oriented composite endpoint (DOCE) comprising cardiac death, target vessel myocardial infarction (TV-MI), clinically driven target lesion revascularization (TLR) and rate of scaffold thrombosis were investigated. RESULTS During a mean follow-up of 33±9 months, DOCE occurred in 9 patients (6.3%) of which cardiac death occurred in 2 patients (1.4%), and clinically driven TLR in 7 patients (4.9%), TV-MI in one patient. Target vessel revascularization (TVR) was observed in nine patients. None of the patients experienced scaffold thrombosis. CONCLUSIONS The use of novolimus-eluting BRS in this real-world population achieved good clinical outcomes.
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Affiliation(s)
- Beytullah Cakal
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul -
| | - Sinem Cakal
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Oguz Karaca
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Mehmet O Omaygenc
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Filiz K Yilmaz
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Haci M Gunes
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Ozgur U Ozcan
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Ersin Ibisoglu
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
| | - Bilal Boztosun
- Department of Cardiology, Faculty of Medicine, Istanbul Medipol University, Bagcilar, Istanbul
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Zheng JF, Qiu H, Tian Y, Hu XY, Luo T, Wu C, Tian Y, Tang Y, Song LF, Li L, Xu L, Xu B, Gao RL. Preclinical Evaluation of a Novel Sirolimus-Eluting Iron Bioresorbable Coronary Scaffold in Porcine Coronary Artery at 6 Months. JACC Cardiovasc Interv 2020; 12:245-255. [PMID: 30732729 DOI: 10.1016/j.jcin.2018.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the operability, 6-month efficacy, and safety of the novel sirolimus-eluting iron bioresorbable coronary scaffold (IBS) system compared with a cobalt-chromium everolimus-eluting stent (EES) (XIENCE Prime stent) in porcine coronary arteries. BACKGROUND Bioresorbable scaffolds have been considered the fourth revolution in percutaneous coronary intervention. However, the first-generation bioresorbable scaffold showed suboptimal results. METHODS Forty-eight IBS and 48 EES were randomly implanted into nonatherosclerotic swine. The operability, efficacy, and safety of the IBS and EES were evaluated using coronary angiography, optical coherence tomography, micro-computed tomography, scanning electron microscopy, and histopathologic evaluation at 7, 14, 28, 90, and 180 days after implantation. RESULTS The operability of the ultrathin IBS (∼70 μm) was comparable with that of the EES, except for its visibility. There was no statistically significant difference in area stenosis between the IBS and EES from 28 to 180 days. The IBS maintained its integrity up to 90 days without corrosion, while corrosion was observed in a few struts in 2 of 10 IBS at 180 days. The percentage of endothelialization of IBS was higher than that of XIENCE Prime stents within 14 days after implantation. The fibrin score was higher in the IBS group at 28 days but comparable with the EES group at 90 and 180 days. No scaffold or stent thrombosis was seen in either group. No abnormal histopathologic changes in scaffolded or stented vessel segments and 5 main remote organs were observed in either group. CONCLUSIONS Preclinical results suggest that the novel IBS has comparable operability, mid-term efficacy, and safety with the EES, and its corrosion profile in porcine coronary arteries is reasonable, which could support initial clinical study of the IBS.
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Affiliation(s)
- Jian-Feng Zheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Qiu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yuan Tian
- Urumqi Friendship Hospital, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Ying Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Tong Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Tian
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Tang
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lai-Feng Song
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Li
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Koolen J. First Larger-Scale Study of the Magnesium Absorbable Stent: How Does It Perform During Implantation? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1146-1147. [PMID: 31870529 DOI: 10.1016/j.carrev.2019.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jeżewski MP, Kubisa MJ, Eyileten C, De Rosa S, Christ G, Lesiak M, Indolfi C, Toma A, Siller-Matula JM, Postuła M. Bioresorbable Vascular Scaffolds-Dead End or Still a Rough Diamond? J Clin Med 2019; 8:E2167. [PMID: 31817876 PMCID: PMC6947479 DOI: 10.3390/jcm8122167] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary interventions with stent-based restorations of vessel patency have become the gold standard in the treatment of acute coronary states. Bioresorbable vascular scaffolds (BVS) have been designed to combine the efficiency of drug-eluting stents (DES) at the time of implantation and the advantages of a lack of foreign body afterwards. Complete resolution of the scaffold was intended to enable the restoration of vasomotor function and reduce the risk of device thrombosis. While early reports demonstrated superiority of BVS over DES, larger-scale application and longer observation exposed major concerns about their use, including lower radial strength and higher risk of thrombosis resulting in higher rate of major adverse cardiac events. Further focus on procedural details and research on the second generation of BVS with novel properties did not allow to unequivocally challenge position of DES. Nevertheless, BVS still have a chance to present superiority in distinctive indications. This review presents an outlook on the available first and second generation BVS and a summary of results of clinical trials on their use. It discusses explanations for unfavorable outcomes, proposed enhancement techniques and a potential niche for the use of BVS.
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Affiliation(s)
- Mateusz P. Jeżewski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Michał J. Kubisa
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Günter Christ
- Department of Cardiology, 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, 31100 Vienna, Austria;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 1061701 Poznań, Poland;
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Jolanta M. Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
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Li C, Mao J, Li Q, Wang F, Jiao Y, Zhang Z, Guidoin R, Wang L. Long-term anticoagulation and selective cells adhesion surface via combination of covalent grafting and layer by layer assembly. Biomed Mater 2019; 14:065012. [DOI: 10.1088/1748-605x/ab452b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhou C, Li HF, Yin YX, Shi ZZ, Li T, Feng XY, Zhang JW, Song CX, Cui XS, Xu KL, Zhao YW, Hou WB, Lu ST, Liu G, Li MQ, Ma JY, Toft E, Volinsky AA, Wan M, Yao XJ, Wang CB, Yao K, Xu SK, Lu H, Chang SF, Ge JB, Wang LN, Zhang HJ. Long-term in vivo study of biodegradable Zn-Cu stent: A 2-year implantation evaluation in porcine coronary artery. Acta Biomater 2019; 97:657-670. [PMID: 31401346 DOI: 10.1016/j.actbio.2019.08.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 01/11/2023]
Abstract
In the present study, a novel biodegradable Zn-0.8Cu coronary artery stent was fabricated and implanted into porcine coronary arteries for up to 24 months. Micro-CT analysis showed that the implanted stent was able to maintain structural integrity after 6 months, while its disintegration occurred after 9 months of implantation. After 24 months of implantation, approximately 28 ± 13 vol% of the stent remained. Optical coherence tomography and histological analysis showed that the endothelialization process could be completed within the first month after implantation, and no inflammation responses or thrombosis formation was observed within 24 months. Cross-section analysis indicated that the subsequent degradation products had been removed in the abluminal direction, guaranteeing that the strut could be replaced by normal tissue without the risk of contaminating the circulatory system, causing neither thrombosis nor inflammation response. The present work demonstrates that the Zn-0.8Cu stent has provided sufficient structural supporting and exhibited an appropriate degradation rate during 24 months of implantation without degradation product accumulation, thrombosis, or inflammation response. The results indicate that the Zn-0.8Cu coronary artery stent is promising for further clinical applications. STATEMENT OF SIGNIFICANCE: Although Zn and its alloys have been considered to be potential candidates of biodegradable metals for vascular stent use, by far, no Zn-based stent with appropriate medical device performance has been reported because of the low mechanical properties of zinc. The present work presents promising results of a Zn-Cu biodegradable vascular stent in porcine coronary arteries. The Zn-Cu stent fabricated in this work demonstrated adequate medical device performance both in vitro and in vivo and degraded at a proper rate without safety problems induced. Furthermore, large animal models have more cardiovascular similarities as humans. Results of this study may provide further information of the Zn-based stents for translational medicine research.
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Affiliation(s)
- Chao Zhou
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, PR China; Department of Interventional and Vascular Surgery, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai 200072, PR China; National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Hua-Fang Li
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, PR China
| | - Yu-Xia Yin
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, PR China; National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Zhang-Zhi Shi
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, PR China
| | - Ting Li
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, PR China
| | - Xiang-Yi Feng
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Jun-Wei Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Cai-Xia Song
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Xiao-Shan Cui
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Kai-Li Xu
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Yan-Wei Zhao
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Wen-Bo Hou
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Shou-Tao Lu
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Guang Liu
- National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China
| | - Mao-Quan Li
- Department of Interventional and Vascular Surgery, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai 200072, PR China
| | - Jian-Ying Ma
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 PR China
| | - Egon Toft
- Biomedical Research Center, College of Medicine, Qatar University, Shareh Jamiaa, Post Box 2716, Doha, Qatar
| | - Alex A Volinsky
- Department of Mechanical Engineering, University of South Florida, Tampa, FL 33620, USA
| | - Min Wan
- Shandong Quality Inspection Center for Medical Devices, No. 15166 Century Avenue, Jinan H-T Industrial Development Zone, Shandong 250101, PR China
| | - Xiu-Jun Yao
- Shandong Quality Inspection Center for Medical Devices, No. 15166 Century Avenue, Jinan H-T Industrial Development Zone, Shandong 250101, PR China
| | - Chang-Bin Wang
- Shandong Quality Inspection Center for Medical Devices, No. 15166 Century Avenue, Jinan H-T Industrial Development Zone, Shandong 250101, PR China
| | - Kang Yao
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 PR China
| | - Shi-Kun Xu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 PR China
| | - Hao Lu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 PR China
| | - Shu-Fu Chang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 PR China
| | - Jun-Bo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 PR China.
| | - Lu-Ning Wang
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, PR China.
| | - Hai-Jun Zhang
- Department of Interventional and Vascular Surgery, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai 200072, PR China; National United Engineering Laboratory for Biomedical Material Modification, Branden Industrial Park, Qihe Economic & Development Zone, Dezhou City, Shandong 251100, PR China; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, Aalborg Ø 9220, Denmark.
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Bayón J, Santás-Álvarez M, Ocaranza-Sánchez R, González-Juanatey C. Bioresorbable magnesium scaffold in complex PCI in a nickel allergy patient: one-year follow-up – no disease, no scaffolds. EUROINTERVENTION 2019; 15:640-641. [DOI: 10.4244/eij-d-18-00400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Blair RW, Dunne NJ, Lennon AB, Menary GH. Multi-objective optimisation of material properties and strut geometry for poly(L-lactic acid) coronary stents using response surface methodology. PLoS One 2019; 14:e0218768. [PMID: 31449528 PMCID: PMC6709949 DOI: 10.1371/journal.pone.0218768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022] Open
Abstract
Coronary stents for treating atherosclerosis are traditionally manufactured from metallic alloys. However, metal stents permanently reside in the body and may trigger undesirable immunological responses. Bioresorbable polymer stents can provide a temporary scaffold that resorbs once the artery heals but are mechanically inferior, requiring thicker struts for equivalent radial support, which may increase thrombosis risk. This study addresses the challenge of designing mechanically effective but sufficiently thin poly(L-lactic acid) stents through a computational approach that optimises material properties and stent geometry. Forty parametric stent designs were generated: cross-sectional area (post-dilation), foreshortening, stent-to-artery ratio and radial collapse pressure were evaluated computationally using finite element analysis. Response surface methodology was used to identify performance trade-offs by formulating relationships between design parameters and response variables. Multi-objective optimisation was used to identify suitable stent designs from approximated Pareto fronts and an optimal design is proposed that offers comparable performance to designs in clinical practice. In summary, a computational framework has been developed that has potential application in the design of high stiffness, thin strut polymeric stents.
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Affiliation(s)
- Ross W. Blair
- School of Mechanical and Aerospace Engineering, Queen’s University, Belfast, United Kingdom
- * E-mail:
| | - Nicholas J. Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin, Ireland
- Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin, Ireland
- School of Pharmacy, Queen’s University, Belfast, United Kingdom
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Alex B. Lennon
- School of Mechanical and Aerospace Engineering, Queen’s University, Belfast, United Kingdom
| | - Gary H. Menary
- School of Mechanical and Aerospace Engineering, Queen’s University, Belfast, United Kingdom
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Bennett J, De Hemptinne Q, McCutcheon K. Magmaris resorbable magnesium scaffold for the treatment of coronary heart disease: overview of its safety and efficacy. Expert Rev Med Devices 2019; 16:757-769. [PMID: 31345074 DOI: 10.1080/17434440.2019.1649133] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Bioresorbable scaffold technology provides transient vessel support with drug-delivery capability without the long-term limitations of the permanent metallic drug-eluting stents (DES). The technology has the potential to overcome many of the safety concerns associated with metallic DES, such as hypersensitivity reactions, late stent thrombosis and progression of atherosclerosis within the stented segment (i.e. neoatherosclerosis). Areas covered: The sirolimus-eluting resorbable magnesium scaffold Magmaris is the only metallic CE-marked resorbable scaffold currently available. This magnesium scaffold is designed for providing a short-term lumen support (up to 3 months) before being completely bioresorbed, eliminating the permanent caging typical of the metallic DES. This review will focus on the device development and characteristics, currently available clinical efficacy and safety data, and potential future perspectives. Expert opinion: The first clinical studies testing this device in a small number of patients have shown promising results with good clinical and safety outcomes up to 3 years' clinical follow-up, supporting the use of Magmaris in simple coronary artery disease.
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Affiliation(s)
- Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven , Leuven , Belgium
| | | | - Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven , Leuven , Belgium
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Cerrato E, Barbero U, Gil Romero JA, Quadri G, Mejia-Renteria H, Tomassini F, Ferrari F, Varbella F, Gonzalo N, Escaned J. Magmaris™ resorbable magnesium scaffold: state-of-art review. Future Cardiol 2019; 15:267-279. [DOI: 10.2217/fca-2018-0081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bioresorbable scaffolds (BRS) have been advocated as the ‘fourth revolution’ in interventional cardiology because they could provide temporary scaffolding and then ‘disappear’ (resorb) potentially significantly improving coronary artery disease treatment. BRS technology has gradually matured, and there are many devices available worldwide, which are currently undergoing preclinical or clinical testing. Due to the concerns related to polylactide scaffolds, magnesium alloy is now one of the most promising resorbable technologies despite available evidences on its performances in vivo are limited to small observational studies. In this state-of-art review we present Magmaris™ (Biotronik AG, Buelach, Switzerland) magnesium-based BRS from bench to bedside, reviewing to date available clinical trial data and current recommendations for its optimal use in clinical practice.
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Affiliation(s)
- Enrico Cerrato
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Umberto Barbero
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | | | - Giorgio Quadri
- Cardiology Department, Interventional Cardiology, SS. Annunziata Savigliano, Cuneo, Italy
| | | | - Francesco Tomassini
- Cardiology Department, Interventional Cardiology, SS. Annunziata Savigliano, Cuneo, Italy
| | - Fabio Ferrari
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ferdinando Varbella
- Cardiology Department, Interventional Cardiology, SS. Annunziata Savigliano, Cuneo, Italy
| | - Nieves Gonzalo
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Javier Escaned
- San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
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Katagiri Y, Serruys PW, Asano T, Miyazaki Y, Chichareon P, Modolo R, Takahashi K, Kogame N, Wykrzykowska JJ, Piek JJ, Onuma Y. How does the failure of Absorb apply to the other bioresorbable scaffolds? An expert review of first-in-man and pivotal trials. EUROINTERVENTION 2019; 15:116-123. [DOI: 10.4244/eij-d-18-00607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wlodarczak A, Garcia LAI, Karjalainen PP, Komócsi A, Pisano F, Richter S, Lanocha M, Rumoroso JR, Leung KF. Magnesium 2000 postmarket evaluation: Guideline adherence and intraprocedural performance of a sirolimus-eluting resorbable magnesium scaffold. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1140-1145. [PMID: 30833209 DOI: 10.1016/j.carrev.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Magmaris bioresorbable magnesium scaffold was successfully tested in in-vitro and in clinical premarket studies. Subsequently the Magmaris postmarket program aimed to review intraprocedural data of at least 2000 patients to assess user preferences, guideline adherence and intraprocedural performance in clinical routine. METHODS This international multicentre survey encompasses data from 356 hospitals across 45 countries. As part of the certification for Magmaris implantation, each hospital had to complete consecutive post-market evaluation forms of their first 10 commercial Magmaris patients. RESULTS From June 2016 to May 2018, data on 2018 implantations were collected. Main reasons for selecting Magmaris was patients' life expectancy (67%, n = 1359) and low or not calcified lesions, (67%, n = 1357). Magmaris was successfully deployed in 99% of cases (n = 1995), predilatation was performed in 95% (n = 1922) and post-dilatation in 87% (n = 1756). Physicians rated the overall performance and the pushability as good or very good in 96% of cases (n = 1799). Guide wire friction, trackability, and conformability were rated as good or very good in 94% of cases, and crossability in 93%. The majority of patients were scheduled to receive dual antiplatelet therapy for up to 12 months. CONCLUSION Generally, implantation guidelines were adhered to and theoretical advantages of the metal scaffold observed in in-vitro tests have translated into practice with good intraprocedural performance outcomes, confirming the controlled roll-out of this novel technology into clinical practice. SUMMARY FOR ANNOTATED TABLE OF CONTENT The Magmaris 2000 program includes the first commercial cases at each hospital. Overall, data on 2018 implantations were collected. The high rate of pre- and post-dilatation as well as other parameters confirm that generally the implantation guidelines are adhered to and the good intraprocedural performance (rated as good or very good in 96%) confirm the theoretical advantages of a metallic scaffold in practice.
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Affiliation(s)
| | | | - Pasi P Karjalainen
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - András Komócsi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Francesco Pisano
- Department of Cardiology, Regional Hospital U. Parini, Aosta, Italy
| | - Stephan Richter
- I. Medizinische Klinik, Hegau-Bodensee-Klinikum, Singen, Germany
| | - Magdalena Lanocha
- Department of Cardiology, MCZ Hospital, Lubin, Poland; Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jose Ramón Rumoroso
- Department of Interventional Cardiology, Hospital de Galdakao (Bizkaia), Galdakao, Bizkaia, Spain
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Brandt-Wunderlich C, Ruppelt P, Zumstein P, Schmidt W, Arbeiter D, Schmitz KP, Grabow N. Mechanical behavior of in vivo degraded second generation resorbable magnesium scaffolds (RMS). J Mech Behav Biomed Mater 2018; 91:174-181. [PMID: 30583263 DOI: 10.1016/j.jmbbm.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/31/2018] [Accepted: 12/10/2018] [Indexed: 01/12/2023]
Abstract
Resorbable magnesium scaffolds are used for the treatment of atherosclerotic coronary vascular disease and furthermore, for vascular restoration therapy. Recently, the first-in-man clinical studies with Magmaris showed promising results regarding the target lesion failure as well as vasomotion properties after 12 and 24 month. The consistency of in vivo degraded magnesium alloys in a cardiovascular environment is qualitatively described in literature, but only little has been disclosed about the actual change in mechanical properties and the behavior of the magnesium alloy degradation products. In the present study, uncoated magnesium scaffolds 3.0 × 20 mm were implanted in coronary arteries of two healthy Goetinnger mini-swine. The scaffolds were explanted to evaluate the mechanical properties of the degraded magnesium scaffolds after 180 days in vivo. Ex vivo sample preparation and test conditions were adapted to a customized compression test setup which was developed to investigate the micro-scale scaffold fragments (width 225 ± 75 µm, thickness 150 µm). As reference bare undegraded magnesium scaffold fragments were tested. Mechanical parameters relating to force as a function of displacement were determined for both sample groups. The undegraded samples showed no fracturing at the maximum applied force of 8 N, whereas the in vivo degraded test samples showed forces of 0.411 ± 0.197 N at the first fracturing and a maximum force of 0.956 ± 0.525 N. The deformation work, calculated as area beneath the force-displacement curve, of the in vivo degraded test samples was reduced by approximately 87-88% compared to the undegraded samples (5.20 mN mm and 40.79 mN mm, both at 7.5% deformation). The indication for a complete loss of structural integrity through a reduction of mechanical properties after a certain degradation time increases the chance to restore vascular function and physiological vasomotion in the stented vessel compartment.
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Affiliation(s)
| | | | | | - Wolfram Schmidt
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Daniela Arbeiter
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Klaus-Peter Schmitz
- Institute for ImplantTechnology and Biomaterials e.V., Rostock-Warnemuende, Germany; Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
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41
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Feasibility of use of magnesium reabsorbable scaffolds in complex coronary artery disease: True bifurcation, multiple overlapping scaffolds and chronic total occlusion treatment. Rev Port Cardiol 2018; 37:1009.e1-1009.e3. [PMID: 30554888 DOI: 10.1016/j.repc.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/07/2017] [Accepted: 08/24/2017] [Indexed: 11/23/2022] Open
Abstract
We present first-in-human treatment with bioabsorbable magnesium scaffolds for percutaneous coronary intervention in a patient with nickel allergy. We present images from angiography and optical coherence tomography at three months. We also review the current status of these novel devices.
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42
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Wlodarczak A, Lanocha M, Jastrzebski A, Pecherzewski M, Szudrowicz M, Jastrzebski W, Nawrot J, Lesiak M. Early outcome of magnesium bioresorbable scaffold implantation in acute coronary syndrome-the initial report from the Magmaris-ACS registry. Catheter Cardiovasc Interv 2018; 93:E287-E292. [PMID: 30537203 DOI: 10.1002/ccd.28036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/24/2018] [Accepted: 12/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The Magmaris-ACS Registry is the first assessment of the Magmaris implantation in the acute coronary syndrome (ACS) population. BACKGROUND Bioresorbable vascular scaffolds (BRS), the newest coronary stent technology, was developed to overcome the limitations of the metallic drug-eluting stents (DES). Current promising data of the Magmaris in patients with stable angina have encouraged to validate the second generation BRS in ACS indications. METHODS The study population consisted of the consecutive patients who underwent PCI with the Magmaris BRS in the settings of ACS. Patients with ST-segment elevation myocardial infarction were excluded from enrolment. Baseline demographic and angiographic characteristics, as well as 30-day and 6-month clinical, follow up were prospectively analyzed. RESULTS Fifty patients were enrolled at mean age 62.9 ± 8.4 years (unstable angina-52% and non-ST-segment myocardial infarction [NSTEMI]-48%). Treated fifty-one de novo lesions were located in LAD (37%), LCx (14%), and RCA (49%), respectively. Angiographic success in the target lesion was 100%. One case of recurrent ischemia was observed a day after the index procedure, due to the significant distal edge dissection a regular metallic DES overlapping Magmaris was implanted. No other in-hospital events occurred (procedural success 98%). Six-Month follow up showed none device-oriented endpoints such as cardiac mortality, target vessel myocardial infarction or target vessel revascularization. None early scaffold thrombosis was reported. CONCLUSION The use of the Magmaris BRS in non-ST elevation ACS patient is associated with a procedural safety and promising early angiographic and clinical outcomes. Long-term follow-up and further evaluation in large prospective randomized controlled trials are needed.
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Affiliation(s)
| | - Magdalena Lanocha
- Department of Cardiology, Poznan University of Medical Sciences, Poland
| | | | | | | | | | - Joanna Nawrot
- Department of Cardiology, Copper Health Center, Lubin, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poland
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43
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Improvement of Mechanical Performance of Bioresorbable Magnesium Alloy Coronary Artery Stents through Stent Pattern Redesign. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8122461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimized stent pattern design can effectively enhance the mechanical performance of magnesium alloy stents by adjusting strain distribution and evolution during stent deformation, thereby overcoming the limitations imposed by the intrinsic mechanical properties of magnesium alloys. In the present study, a new stent design pattern for magnesium alloys was proposed and compared to two existing stent design patterns. Measures of the mechanical performance of these three stents, including crimping and expanding deformability, radial scaffolding capacity, radial recoil and bending flexibility, were determined. Three-dimensional finite element (FE) models were built to predict the mechanical performance of the stents with the three design patterns and to assist in understanding the experimental results. The results showed that, overall, the stent with the new design pattern was superior to the stents based on the existing designs, though the expanding capacity of the newly designed stent still needed to be improved.
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44
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Bayón J, Santá-Álvarez M, Ocaranza-Sánchez R, González-Juanatey C. Feasibility of use of magnesium reabsorbable scaffolds in complex coronary artery disease: True bifurcation, multiple overlapping scaffolds and chronic total occlusion treatment. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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45
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Blachutzik F, Achenbach S, Tröbs M, Marwan M, Weissner M, Nef H, Schlundt C. Effect of non‐compliant balloon postdilatation on magnesium‐based bioresorbable vascular scaffolds. Catheter Cardiovasc Interv 2018; 93:202-207. [DOI: 10.1002/ccd.27794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/31/2018] [Accepted: 06/24/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Florian Blachutzik
- Department of CardiologyFriedrich‐Alexander Universität Erlangen‐Nürnberg Erlangen Germany
- Department of Cardiology and AngiologyJustus‐Liebig Universität Giessen, Medical Clinic I Germany
| | - Stephan Achenbach
- Department of CardiologyFriedrich‐Alexander Universität Erlangen‐Nürnberg Erlangen Germany
| | - Monique Tröbs
- Department of CardiologyFriedrich‐Alexander Universität Erlangen‐Nürnberg Erlangen Germany
| | - Mohamed Marwan
- Department of CardiologyFriedrich‐Alexander Universität Erlangen‐Nürnberg Erlangen Germany
| | - Melissa Weissner
- Zentrum für KardiologieUniversity Hospital Mainz Mainz Germany
- German Center for Cardiac and Vascular Research (DZHK) Mainz Germany
| | - Holger Nef
- Department of Cardiology and AngiologyJustus‐Liebig Universität Giessen, Medical Clinic I Germany
| | - Christian Schlundt
- Department of CardiologyFriedrich‐Alexander Universität Erlangen‐Nürnberg Erlangen Germany
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Zhao F, Xue W, Wang F, Liu L, Shi H, Wang L. Composite self-expanding bioresorbable prototype stents with reinforced compression performance for congenital heart disease application: Computational and experimental investigation. J Mech Behav Biomed Mater 2018; 84:126-134. [PMID: 29775814 DOI: 10.1016/j.jmbbm.2018.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022]
Abstract
Stents are vital devices to treat vascular stenosis in pediatric patients with congenital heart disease. Bioresorbable stents (BRSs) have been applied to reduce challenging complications caused by permanent metal stents. However, it remains almost a total lack of BRSs with satisfactory compression performance specifically for children with congenital heart disease, leading to importantly suboptimal effects. In this work, composite bioresorbable prototype stents with superior compression resistance were designed by braiding and annealing technology, incorporating poly (p-dioxanone) (PPDO) monofilaments and polycaprolactone (PCL) multifilament. Stent prototype compression properties were investigated. The results revealed that novel composite prototype stents showed superior compression force compared to the control ones, as well as recovery ability. Furthermore, deformation mechanisms were analyzed by computational simulation, which revealed bonded interlacing points among yarns play an important role. This research presents important clinical implications in bioresorbable stent manufacture and provides further study with an innovative stent design.
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Affiliation(s)
- Fan Zhao
- College of Textiles, Donghua University, Shanghai 201620, China; Key laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai 201620, China
| | - Wen Xue
- College of Textiles, Donghua University, Shanghai 201620, China; Key laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai 201620, China
| | - Fujun Wang
- College of Textiles, Donghua University, Shanghai 201620, China; Key laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai 201620, China.
| | - Laijun Liu
- College of Textiles, Donghua University, Shanghai 201620, China; Key laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai 201620, China
| | - Haoqin Shi
- College of Textiles, Donghua University, Shanghai 201620, China
| | - Lu Wang
- College of Textiles, Donghua University, Shanghai 201620, China; Key laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Songjiang District, Shanghai 201620, China.
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47
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Haude M, Ince H, Kische S, Abizaid A, Tölg R, Alves Lemos P, Van Mieghem NM, Verheye S, von Birgelen C, Christiansen EH, Wijns W, Garcia-Garcia HM, Waksman R. Sustained safety and clinical performance of a drug-eluting absorbable metal scaffold up to 24 months: pooled outcomes of BIOSOLVE-II and BIOSOLVE-III. EUROINTERVENTION 2018; 13:432-439. [PMID: 28504239 DOI: 10.4244/eij-d-17-00254] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS We aimed to assess the safety and performance of the DREAMS 2G scaffold up to 24 months post implant. METHODS AND RESULTS The present study population comprises a total of 184 patients with 189 lesions who were enrolled in the prospective, multicentre BIOSOLVE-II and BIOSOLVE-III trials. Clinical follow-up was scheduled at one, six, 12, 24 and 36 months. The present report includes pooled follow-up data at six months and BIOSOLVE-II data at 24 months. Patients were 65.5±10.8 years old, and lesions were 12.5±5.1 mm long with reference diameters of 2.7±0.4 mm. Procedural success was obtained in 97.8%. At six months, the composite clinical endpoint target lesion failure was 3.3% (95% CI: 1.2-7.1), based on two cardiac deaths (1.1%, one unknown and one not device-related), one target vessel myocardial infarction (0.6%), and three clinically driven target lesion revascularisations (1.7%). For BIOSOLVE-II at 24 months, the target lesion failure rate was 5.9% (95% CI: 2.4-11.8), based on two cardiac deaths (1.7%), one target vessel myocardial infarction (0.9%) and four target lesion revascularisations (3.4%). There was no definite or probable scaffold thrombosis. CONCLUSIONS The present analysis provides additional evidence on the safety of a drug-eluting absorbable metal scaffold with promising clinical outcomes up to 24 months and absence of definite or probable scaffold thrombosis.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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48
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Bennett J, Vanhaverbeke M, Vanden Driessche N, Hiltrop N, Adriaenssens T, Desmet W, Sinnaeve P, Dubois C. The drug-eluting resorbable magnesium vascular scaffold in complex coronary bifurcations: insights from an in vivo multimodality imaging study. EUROINTERVENTION 2018; 13:2036-2046. [DOI: 10.4244/eij-d-17-00248] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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49
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Quadri G, Tomassini F, Cerrato E, Varbella F. First reported case of magnesium-made bioresorbable scaffold to treat spontaneous left anterior descending coronary artery dissection. Catheter Cardiovasc Interv 2017; 90:768-772. [PMID: 28766909 DOI: 10.1002/ccd.27214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of Acute Coronary Syndrome. Although its treatment is still debated, use of Bioreasorbable Scaffold was recently advocated as an attractive option in this setting. We report the first case, to our knowledge, of a new magnesium-made Bioresorbable Scaffold implantation in a young woman presenting with Non-ST- Elevation Myocardial Infarction and a rapid worsening SCAD.
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Affiliation(s)
- Giorgio Quadri
- Interventional Cardiology Unit, ASL TO3, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Tomassini
- Interventional Cardiology Unit, ASL TO3, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Enrico Cerrato
- Interventional Cardiology Unit, ASL TO3, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Ferdinando Varbella
- Interventional Cardiology Unit, ASL TO3, Infermi Hospital, Rivoli, Italy.,San Luigi Gonzaga Hospital, Orbassano, Italy
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50
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Mattesini A, Bartolini S, Sorini Dini C, Valente S, Parodi G, Stolcova M, Meucci F, Di Mario C. The DESolve novolimus bioresorbable Scaffold: from bench to bedside. J Thorac Dis 2017; 9:S950-S958. [PMID: 28894601 PMCID: PMC5583086 DOI: 10.21037/jtd.2017.07.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 11/06/2022]
Abstract
The DESolve (Elixir Medical Corporation, Sunnyvale, California, USA) is a poly-L lactide-based polymer scaffold coated with the antiproliferative and anti-inflammatory drug novolimus. The scaffold biodegrades within one year with a complete resorption in two years and in vitro bench test have shown the ability to supply the necessary radial strength to support the vessel for the critical 3- to 4-month period after implant. The DESolve showed the unique self-correction property, which may reduce the incidence of minor malapposition after deployment. Overexpansion with DESolve is safe since a high capability resistance to fracture has been demonstrated with this scaffold. The aim of this review is to provide a comprehensive overview of the available preclinical and clinical data regarding the DESolve.
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Affiliation(s)
- Alessio Mattesini
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Simone Bartolini
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Carlotta Sorini Dini
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Serafina Valente
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Guido Parodi
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
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